north dakota child care and school infectious disease
TRANSCRIPT
Updated 04/2021
1
Exclusion of Ill Individuals from Child
Care or School
The following table outlines the recommendations from the North Dakota Department of Health
(NDDoH) for exclusion for specific diseases. These guidelines should be followed unless a school
or child care facility has a more stringent policy in place. For more information about these
conditions, please visit https://www.health.nd.gov/diseases-conditions or call 800-472-2180.
General Exclusion Criteria
Child Care:
Regardless of the disease, children should be excluded from child care if they meet any of the
following exclusion criteria:
1. The staff determines the child is unwilling or unable to participate in activities due to
illness.
2. The staff determines that they cannot care for the sick child without compromising their
ability to care for the health and safety of the other children in the group.
3. The child has a fever (oral temperature above 100.4°F, axillary temperature above 100°F,
rectal temperature above 100.4°F) along with difficulty breathing, changes in behavior,
lethargy, irritability, or persistent crying.
4. The child experiences vomiting two or more times in the preceding 24 hours, unless
determined to be caused by a non-communicable condition and child is able to remain
hydrated and participate in activities.
5. The child has diarrhea and stool is not contained in diaper or if fecal accidents occur in a
child who is toilet trained, or if stool frequency exceeds two or more stools above normal
for that child, or if stool contains blood or mucus.
6. Persistent abdominal pain (two or more hours) or intermittent abdominal pain associated
with fever, dehydration or other systemic signs and symptoms.
7. Oral lesions if the child is unable to contain drool or if unable to participate because of
other symptoms or until the child is considered to be noninfectious.
8. Skin lesions if they are weeping/draining/oozing and unable to be kept covered with a
waterproof dressing.
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School:
Regardless of the disease, children should be excluded from school if they meet any of the
following exclusion criteria:
1. The staff determines the child is unwilling or unable to participate in activities due to
illness.
2. The staff determines that they cannot care for the sick child without compromising their
ability to care for the health and safety of the other children in the group.
3. The child has a fever (oral temperature above 100.4°F, axillary temperature above 100°F,
rectal temperature above 100.4°F) along with difficulty breathing, changes in behavior,
lethargy, irritability, or persistent crying.
4. The child experiences vomiting two or more times in the preceding 24 hours, unless
determined to be caused by a non-communicable condition and the child is able to
remain hydrated and participate in activities.
5. The individual has diarrhea and cannot self-contain stool.
If you suspect or know of a child attending your child care center or school that has one of the
conditions listed below with a reportable conditions symbol (), please call the NDDoH Division
of Disease Control at 800-472-2180 to report.
Disease Child Care Exclusion School Exclusion Return
Bacterial
meningitis
Yes. Yes. When a health professional
determines they are no longer
contagious.
Bronchitis
No, unless general
exclusions apply.
No, unless general
exclusions apply.
Campylobacteriosis
(Campylobacter)
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
when diarrhea resolves.
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Disease Child Care Exclusion School Exclusion Return
Chickenpox
Yes, children and staff
should be excluded.
Exposed children or staff
without symptoms do not
need to stay home unless
chickenpox develops.
Disease may be prevented
after exposure if
unvaccinated individuals
are vaccinated within
three to five days of being
exposed to chickenpox.
Yes, children and staff
should be excluded.
Exposed children or staff
without symptoms do not
need to stay home unless
chickenpox develops.
Disease may be prevented
after exposure if
unvaccinated individuals
are vaccinated within
three to five days of being
exposed to chickenpox.
Children or staff should be
excluded until all blisters have
dried into scabs and no new
blisters have started for 24
hours or in immunized
individuals without scabs,
until the blisters are resolving.
This usually takes five to six
days.
Cholera
(Vibrio cholerae)
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
when diarrhea resolves.
Clostridium
difficile
Yes, children should be
excluded.
No, unless general
exclusions apply.
Child in child care may return
when stools are contained in
the diaper or child is able to
control diarrhea and stool
frequency is no more than
two stools above that child’s
normal frequency.
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Disease Child Care Exclusion School Exclusion Return
COVID-19 Yes, children and staff
should be excluded.
Exposed persons:
Fully vaccinated people (2
weeks following the
completion of COVID-19
vaccine series) who are
not showing symptoms
do not need to be
excluded.
Masked exposed persons
who were exposed to
masked infected persons
do not need to be
excluded.
All others exposed should
be excluded from child
care regardless of
symptoms.
Yes, children and staff
should be excluded.
Exposed persons:
Fully vaccinated people (2
weeks following the
completion of COVID-19
vaccine series) who are
not showing symptoms
do not need to be
excluded.
Masked exposed persons
who were exposed to
masked infected persons
do not need to be
excluded.
All others exposed should
be excluded from school
regardless of symptoms.
Children and staff may return
when 10 days have passed
since their symptoms began
and they are fever free for 24
hours without the use of
fever-reducing medications
and symptoms are improving.
Excluded exposed persons
may return using one of the
following criteria.
• 14 days from the last
exposure to someone
who tested positive.
• 10 days after the last
exposure to someone
who tested positive
and remained
symptom free.
• 7 days if symptom
free and tested
negative day 5 or later
after exposure to
positive individual.
Cryptosporidiosis
(Crypto)
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
when diarrhea resolves.
Ear infection
No, unless general
exclusions apply.
No, unless general
exclusions apply.
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Disease Child Care Exclusion School Exclusion Return
E. coli O157:H7 and
all other Shiga
toxin-producing E.
coli (STEC)
Yes.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
when diarrhea resolves and
two consecutive negative
stool samples are obtained at
least 24 hours apart and 48
hours after completion of
antibiotics.
Food handlers must be
excluded from handling food
until the regulatory authority
grants approval for their
return and two consecutive
negative stool samples are
obtained at least 24 hours
apart and 48 hours after
completion of antibiotics or
the worker has been
asymptomatic for at least
seven days.
Flu (Influenza)
Yes, children and staff
should be excluded.
Yes, children and staff
should be excluded.
Children and staff can return
when they are fever free for
24 hours without the use of
fever reducing medicine.
Fifth disease
No, unless general
exclusions apply.
No, unless general
exclusions apply.
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Disease Child Care Exclusion School Exclusion Return
Fungal infections
of the skin
(Ringworm,
Athlete’s foot, etc.)
Yes, but not until the end
of the day.
Children with ringworm
can attend child care as
long as treatment has
been started. When
possible, the affected area
should be covered.
However, all people with
fungal infections should
be excluded from certain
activities that are likely to
expose others to the
fungus, such as using
swimming pools, showers,
towels at public gyms, etc.
Yes, but not until the end
of the day.
Children with ringworm
can attend school as long
as treatment has been
started. When possible,
the affected area should
be covered.
However, all people with
fungal infections should
be excluded from certain
activities that are likely to
expose others to the
fungus, such as using
swimming pools, showers,
towels at public gyms, etc.
Athletes with ringworm can
compete in matches 72 hours
after starting treatment and
when the affected area can be
covered.
Giardiasis (Giardia)
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
when diarrhea resolves.
Hand, foot &
mouth disease
(HFMD)
No, unless general
exclusions apply.
No, unless general
exclusions apply.
Head lice
Yes, but not until the end
of the day.
No. Exclusion and treatment of
children in child care can
occur at the end of the day
with return the following day.
Children can remain in school,
but should be treated for lice
as soon as possible.
Head-to-head contact with
other children should be
discouraged.
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Disease Child Care Exclusion School Exclusion Return
Hepatitis A
Yes.
All symptomatic child care
staff should be excluded.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
seven days after onset of
symptoms.
Food handlers must be
excluded from handling food
until the regulatory authority
grants approval for their
return and at least seven days
have passed since the onset
of jaundice or 14 days have
passed since the onset of
symptoms other than
jaundice.
Hepatitis B No.
No.
Hepatitis C No.
No.
Herpes simplex
“cold sores”
No, unless child has
mouth sores or blisters
and does not have control
of drooling or other
exclusions apply.
For primary infections, no,
unless child has mouth
sores or blisters and does
not have control of
drooling or other
exclusions apply.
For recurrent infections,
no exclusion.
If uncontrolled drooling, child
may return once mouth sores
are gone.
Hib (Haemophilus
influenzae type B)
Yes.
Exposed children and staff
do not need to be
excluded.
Yes.
Exposed children and staff
do not need to be
excluded.
Children should be excluded
until a health professional
determines they are no longer
contagious.
HIV
No. No.
Impetigo Yes, but not until the end
of the day.
Yes, but not until the end
of the day.
Children can return after
starting treatment and as
long as draining lesions can
be covered.
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Disease Child Care Exclusion School Exclusion Return
Measles
Yes, children and staff
should be excluded.
Exposed persons:
Vaccinated people who
are not showing
symptoms do not need to
be excluded.
Unvaccinated people who
have been exempted from
measles immunization for
medical, religious, moral
or philosophical reasons
must be immunized
within 72 hours of
exposure.
Yes, children and staff
should be excluded.
Exposed persons:
Vaccinated people who
are not showing
symptoms need not be
excluded.
Unvaccinated people who
have been exempted from
measles immunization for
medical, religious, moral
or philosophical reasons
must be immunized
within 72 hours of
exposure.
Children and staff who are
infected with the measles
virus can return after the rash
has been present for four
days.
If unvaccinated people are
not vaccinated within 72
hours, they should be
excluded from all activities
until the NDDoH determines
it is safe for them to return.
Meningococcal
meningitis
(Neisseria
meningitidis)
Yes children and staff
should be excluded.
Yes, children and staff
should be excluded.
People should be excluded
until at least 24 hours after
antibiotic therapy was started
and the illness has subsided.
Molluscum
(Molluscum
contagiosum)
No.
However, lesions should
be covered.
No.
However, children
participating in close
contact sports, such as
wrestling, should be
excluded if lesions are
visible and cannot be
covered.
Infectious
mononucleosis
(Mono)
No, unless general
exclusions apply.
No, unless general
exclusions apply.
MRSA (Methicillin-
resistant
Staphylococcus
aureus)
No, unless the wound
cannot be covered or
general exclusions apply.
No, unless the wound
cannot be covered or
general exclusions apply.
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Disease Child Care Exclusion School Exclusion Return
Mumps Yes, children and staff
should be excluded.
Yes, children and staff
should be excluded.
Children and staff should be
excluded for five days after
symptom onset.
Norovirus
Yes. Yes. Children and staff may return
48 hours after diarrhea and/or
vomiting has resolved.
Pertussis
(Whooping cough)
Yes, children and staff
should be excluded.
Symptomatic contacts
(contacts with a cough) of
pertussis cases also
should be excluded from
activities until five days of
antibiotic treatment are
completed.
Contacts without
symptoms do not need to
be excluded.
Yes, children and staff
should be excluded.
Symptomatic contacts
(contacts with a cough) of
pertussis cases also
should be excluded from
activities until five days of
antibiotic treatment are
completed.
Contacts without
symptoms do not need to
be excluded.
Children and staff may return
after they have completed
five days of appropriate
antibiotics or if they have
been coughing for more than
21 days.
Pinkeye No, unless general
exclusions apply.
No, unless general
exclusions apply.
Pinworms No.
No.
Pneumonia No, unless general
exclusions apply.
No, unless general
exclusions apply.
Rotavirus
No, unless general
exclusions apply.
No, unless general
exclusions apply.
Children and staff can return
when diarrhea resolves.
RSV (Respiratory
syncytial virus)
No, unless child exhibits
rapid or labored breathing
or general exclusions
apply.
No, unless child exhibits
rapid or labored breathing
or general exclusions
apply.
Children can return when they
are fever free for 24 hours
without the use of fever
reducing medicine.
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Disease Child Care Exclusion School Exclusion Return
Rubella Yes, children and staff
should be excluded.
Exposed persons:
Vaccinated people who
are not showing
symptoms need not be
excluded.
Unvaccinated people who
have been exempted from
MMR immunization for
medical, religious, moral
or philosophical reasons
must be immunized
within 72 hours of
exposure.
Yes, children and staff
should be excluded.
Exposed persons:
Vaccinated people who
are not showing
symptoms need not be
excluded.
Unvaccinated people who
have been exempted from
MMR immunization for
medical, religious, moral
or philosophical reasons
must be immunized
within 72 hours of
exposure.
Children and staff should be
excluded for seven days after
rash onset.
If unvaccinated people are
not vaccinated within 72
hours, they should be
excluded from all activities
until the NDDoH determines
it is safe for them to return.
Salmonellosis
(Nontyphoidal
Salmonella)
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
when diarrhea resolves.
Food handlers must be
excluded from handling food
until the regulatory authority
grants approval for their
return and two successive
negative stool samples are
obtained at least 24 hours
apart and 48 hours after
completion of antibiotics or
the worker has been
asymptomatic for 30 days.
Scabies Yes, children and staff
should be excluded, but
not until the end of the
day.
Yes, children and staff
should be excluded, but
not until the end of the
day.
Children and staff may return
when treatment is complete.
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Disease Child Care Exclusion School Exclusion Return
Shigellosis
(Shigella)
Yes.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff can return
24 hours after diarrhea has
resolved and one negative
stool sample is obtained.
Food handlers must be
excluded from handling food
until the regulatory authority
grants approval for their
return and two successive
negative stool samples are
obtained at least 24 hours
apart and 48 hours after
completion of antibiotics or
the worker has been
asymptomatic for seven days.
Shingles (Herpes
zoster)
No, unless lesions cannot
be covered.
No, unless lesions cannot
be covered.
Children and staff who are
excluded may return after the
lesions have crusted.
Strep throat
(Group A
Streptococcus)
Yes, children and staff
should be excluded.
Yes, children and staff
should be excluded.
Children and staff may return
when they have been on
appropriate antibiotics for 12
hours.
Streptococcus
pneumoniae
(invasive)
No, unless general
exclusions apply.
No, unless general
exclusions.
Tuberculosis
(TB)
Yes, children and staff
with TB disease should be
excluded until cleared to
return by a medical
provider.
Children and staff with
latent TB infection can
participate in all activities
whether they are receiving
treatment or not.
Yes, children and staff
with TB disease should be
excluded until cleared to
return by a medical
provider.
Children and staff with
latent TB infection can
participate in all activities
whether they are receiving
treatment or not.
Children and staff with TB
disease should be excluded
from school, child care or the
work place until the sputum
cultures are negative (about
two to four weeks after the
beginning of treatment) and
cleared to return by a medical
provider.
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Disease Child Care Exclusion School Exclusion Return
Typhoid Fever
(Salmonella Typhi
or Paratyphi)
Yes.
Yes. Children and staff may return
when diarrhea resolves and
three consecutive negative
stool samples are obtained at
least 24 hours apart and 48
hours after antibiotics are
completed.
Food handlers must be
excluded from handling food
until the regulatory authority
grants approval for their
return.
Vibriosis No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
No, unless general
exclusions apply.
Exclude symptomatic staff
who handle food.
Children and staff may return
when diarrhea resolves.
Procedure for Excluding a Child
1. Ask the child’s parent or guardian to pick up the child as soon as possible.
2. The teacher or caregiver will provide care for the child in a place where the child will be
comfortable and away from other children, while still being supervised. The child should
continue to be observed for new or worsening symptoms.
3. Follow the advice of the child’s health care professional or the NDDoH.
4. Contact the NDDoH if there is a question about a reportable communicable disease.
Document actions in the child’s file with date, time, symptoms, and actions taken (and by
whom); sign and date the document.
5. Sanitize toys and other items the child may have put in his or her mouth and continue to
practice good hand hygiene.
Criteria for Excluding Child Care/School Staff
It is important to remember that diseases are not just spread by children to other children, but
from staff to children as well as children to staff. Please encourage staff to discuss their health
concerns with their health care provider or your facility’s health consultant.
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References
American Academy of Pediatrics. [Children in Out-Of-Home Care]. In: Kimberlin DW, Brady MT,
Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st
ed. Itasca, IL: American Academy of Pediatrics; 2018: [122-146].
American Academy of Pediatrics, American Public Health Association, National Resource Center
for Health and Safety in Child Care and Early Education. Caring for Our Children: National Health
and Safety Performance Standards; Guidelines for Early Care and Education Programs. 4th ed.
Itasca, IL: American Academy of Pediatrics; 2019: [141-147].
North Dakota Century Code, Food Code, 33-33-04.1:
www.legis.nd.gov/information/acdata/pdf/33-33-04.1.pdf.
North Dakota Century Code, Reportable Diseases, 23-07
https://www.legis.nd.gov/cencode/t23c07.pdf